Preliminary Diagnosis: Testicular Cancer
I. What imaging technique is first-line for this diagnosis?
Ultrasound of the scrotum and bilateral testicles.
II. Describe the advantages and disadvantages of this technique for diagnosing testicular cancer.
Advantages
- Highly portable and does not expose patients to ionizing radiation.
- Details the velocity and direction of vascular flow.
- May help guide percutaneous biopsy.
- Offers moderate sensitivity and specificity in characterizing the surrounding soft tissues.
- Details the local extent and infiltration of the primary tumor and distant metastatic disease.
Disadvantages
- Highly operator dependent.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to ultrasound exist.
IV. What alternative imaging techniques are available?
- CT imaging with IV contrast.
- MR imaging with IV contrast.
- PET/CT imaging.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing testicular cancer.
CT imaging with IV contrast
Advantages
- Offers exquisite detail of the surrounding soft tissues, osseous structures, and vasculature.
- Highly sensitive and specific in detailing the local extent and infiltration of the primary neoplasm and may detail any surrounding suspicious distant metastatic disease.
- May help guide percutaneous biopsy, treatment, and therapy.
Disadvantages
- Exposes patients to ionizing radiation.
- Less sensitive and specific in detailing primary and distant metastatic disease compared to PET/CT imaging.
MR imaging with IV contrast
Advantages
- Does not expose patients to ionizing radiation.
- Better details the surrounding soft tissues than other imaging modalities.
Disadvantages
- Expensive.
- Time consuming.
- Offers limited evaluation of the surrounding osseous structures.
- May be subject to motion and susceptibility weighted artifact, degrading image quality.
PET/CT imaging
Advantages
- Highly sensitive and specific in detecting local testicular neoplastic disease and detailing distant metastatic disease.
- Gold standard in staging neoplasm, which directs treatment.
- Offers exquisite anatomical and functional detail of the surrounding soft tissues, vasculature, and osseous structures.
Disadvantages
- May be subject to motion artifact and further imaging artifact secondary to blood glucose, movement, and many more false positives and negatives.
- Exposes patients to ionizing radiation.
VI. What are the contraindications for the alternative imaging techniques?
CT imaging with IV contrast
- May be contraindicated in pregnant patients.
- May be contraindicated in patients with renal failure or contrast allergy.
MR imaging with IV contrast
- May be contraindicated in patients with non MR compatible hardware.
PET/CT imaging
- May be contraindicated in pregnant patients and those that are breast feeding.
Continue Reading
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
